The Opioid Commission’s First Recommendations for President Trump

On Wednesday, President Donald J. Trump’s opioid commission, led by New Jersey’s own Gov. Chris Christie, put out its recommendations to deal with the nation’s opioid overdose crisis only days after Trump declared it a public health emergency. An emergency that has contributed to the US’s record 64,000 drug overdose deaths in 2016.

The commission’s list includes more than 50 recommendations, touching on federal, state and local agencies. They include streamlining federal money for drug addiction, knocking down barriers to treatment, expanding federal drug courts, and implementing new training requirements for doctors who prescribe opioid painkillers. The commission did not say how much funding these recommendations will require, leaving a huge unanswered question.

With its final report, the commission ends months of work in which it met with major stakeholders involved in the crisis, from people struggling with addiction, especially in opioid overdose treatment to insurers and pharmaceutical companies.

The Opioid Commission’s Recommendations: The Biggest

Streamline federal funding for drug addiction: According to the report, nearly every governor’s office complained about the broken state of federal funding for opioids and addiction. The report recommends streamlining the current process into a block grant, which should require “one application and one set of reporting requirements” for funding. The commission is arguing that this would let states focus less on paperwork and more on implementing policies.

Remove barriers to treatment: The report also proposes several moves for federal agencies to remove barriers to opioid overdose treatment, including better enforcement of parity laws that in theory require insurers to pay for such care. But it does not call for a new, large federal investment into treatment. Which could be an issue considering only 10% of Americans with drug use disorders get specialty treatment—mainly because they can’t afford the services and even when they can they face long waiting periods.

Open drug courts in all federal jurisdictions: Drug courts, which divert people from prison to opioid overdose treatment, were up and running in less than 30 percent of federal districts in 2015 according to the report. The commission said this should be 100 percent. The argument is harm reduction. Drug courts get people treatment instead of prison time. But drug courts have been criticized for frequently ignoring evidence based treatment options including anti-addiction medications like methadone and Buprenorphine.

More opioid prescriber training: The commission asks that the Department of Health and Human Services develop “a national curriculum and standard of care for opioid prescribers.” It also proposes that the DEA require doctors renewing their prescribing licenses to attend an education program for such prescriptions.

Stop evaluating doctors based on pain scores: One of the reasons for the rise in prescription of opioids is doctors were commonly rated on government mandated surveys based on how well they treated a patient’s self-reported pain. This encouraged doctors to prescribe painkillers that could lead to short term improvements but in the long term could lead to addiction, overdose and other problems. To end this incentive to prescribe, the commission asks that patient satisfaction surveys used to evaluate doctors no longer include questions about pain.

Allow more emergency responders to deploy naloxone: The National Highway Traffic Safety Administration currently puts out best practices that suggest specific emergency responders carry naloxone. The commission wants to make sure that ALL emergency medical staff, which some states don’t allow, can carry it. But this report doesn’t extend to opening access to naloxone beyond that.

Tougher prison sentences for Fentanyl: The commission calls for an increase in federal sentencing penalties for trafficking Fentanyl. The empirical evidence shows that this will have little to no effect on drug use.

A media campaign: The report recommends a federally funded media campaign on addiction stigma and the dangers of opioids. This is one of Trump’s favorite ideas, which he has said before. The research however, shows that these campaigns often fail or lead to more drug use by making the drugs appear as an active form of rebellion or even by triggering curiosity.

This is a brief overview of the main recommendations by the opioid commission. So far the reaction has been mixed. You can read the whole report here: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf

For more information on opioid overdose treatment, please contact GateHouse Treatment today.